Healthcare Provider Details

I. General information

NPI: 1235294026
Provider Name (Legal Business Name): SCOTT A CAPESIUS D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/22/2006
Last Update Date: 09/30/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

850C LOMBARDI AVE
GREEN BAY WI
54304-3768
US

IV. Provider business mailing address

850C LOMBARDI AVE
GREEN BAY WI
54304-3768
US

V. Phone/Fax

Practice location:
  • Phone: 920-430-7400
  • Fax: 920-430-7405
Mailing address:
  • Phone: 920-430-7400
  • Fax: 920-430-7405

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NN0400X
TaxonomyNeurology Chiropractor
License Number3491
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: